Assisted Living vs. Memory Care: Understanding Person-Environment Fit Model and Transitions Theory

As it becomes apparent that your loved one needs extra support in his or her daily life, it can be difficult to know the necessary type of support.  There is a large continuum of care available to elders with many more options than 50 years ago.  So, how do you know what type of care fits your loved ones needs?  How can the care adapt as your loved one’s needs change?

First, let’s take a look at two models used to inform care and when a move or transition is needed: the Person-Environment Fit Model (P-E Fit) and Transitions Theory.  These are models used in the gerontological field to help determine care settings.

Person-Environment Fit Model (P-E Fit)

The P-E Fit Model provides insight into the person and environmental factors that influence health outcomes, in other words, it is focused on the relationship between the person and the environment he or she is living in.  Below is a graphic description of this model.  The y-axis is personal competence; this is the health, cognition, motor skills, and sensory perception of the individual; in other words, their physical and cognitive abilities.  The x-axis is the environmental press, meaning the demands the environment places upon the person living there.  Think of the demands of the environment as the tasks that need to be completed to live in that environment, such as household chores, home maintenance, shopping, cleaning, etc. and the personal tasks like managing medications, eating, toileting, grooming, bathing, dressing, etc.  Basically, the higher the environmental press, the higher the personal competence needed to live in that environment.

The area where personal competence and environmental press meet is depicted as a band.  If the elder falls within this band, he or she would be “in fit”, meaning his or her abilities align with the demands of the environment.  If the elder does not fall within the band, he or she would be “out of fit”, meaning their personal abilities do not align with the demands of their environment.  If someone is out of fit, they cannot safely live in that environment and two things can happen:  the environment can be adapted or there can be changes to the personal competence through another person supporting him or her.

How does the environment adapt?  It can adapt in multiple ways.  The place of living can be simplified physically by eliminating trip hazards, putting everything needed on one level, eliminating clutter or too many items, etc.  Or, the environment can be changed by moving to an assisted living, memory care, skilled nursing facility, etc. based on the needs of that individual.  By changing the environment to a level that matches the personal competence, the person can thrive in fit. 

How can personal competence adapt?  To expect that a person with dementia will adapt to meet the demands of environmental press is unrealistic.  But, that does not mean that someone else cannot bridge that gap.  If the person with dementia is living at home or in independent living, a family member or hired in-home care could provide the competence needed.  If the person with dementia is in assisted living, the care staff may bridge the gap.  But, there will come a time when the needs of the person with dementia will outgrow what the assisted living can provide. 

Transitions Theory

In Transitions Theory, a transition occurs when the individual’s established behavior patterns are no longer adequate for the demands of the situation and the assumptions about oneself or the world are challenged.  The transition is subjective to each individual to the recognition of change, meaning a transition happens when the person can perceive there is a change happening.  Commonly occurring transitions later in life include relocation, changes in health or function, loss of relationships, and role changes.  A transition can trigger another transition, for example, loss of function can trigger a need for relocation, which can cause disorientation.

Memory Care or Assisted Living?

Now let us circle back to making a decision between a memory care or an assisted living.  Using what we know about P-E Fit and Transitions Theory can help us make a decision.  No one is a fortuneteller who can predict the future, but you are able to make educated choices to help reduce rocky changes. 

It is important to understand the services available in each setting, how the services can grow with the resident, and any limitations in services.  Let’s take a look at the average assisted living and the average memory care home in the chart below, please note this is not an exhaustive list.

Assisted LivingMemory care
Available ServicesEnvironmental support (i.e. Housekeeping and laundry).
Assistance with ADLs.
Simple physical environment.
Signage for cuing.
Visible staff.
Structured social activities.
Health monitoring.
Environmental support (i.e. Housekeeping and laundry).
Assistance with ADLs.
Simple physical environment.
Signage for cuing.
Visible staff.
Structured social activities.
Health monitoring.
Managing symptoms of dementia.
Specialized activities for people with dementia.
Dementia specific staff training.
Secured entry.
LimitationsManaging symptoms of dementia past early stage.
Specialized activities for people with dementia.
Health condition that requires 24 hour monitoring by a nurse.
Managing behavioral symptoms.
Health condition that requires 24 hour monitoring by a nurse.
Unsafe behavioral symptoms by residents.

How do you know what is right for you?  We are not able to answer that for you, but you can apply this information to the unique situation of your loved one and his or her needs.  You can assess the needs, personal competence, environmental press, and transitions and make an informed decision for or with your loved one.

What Can Parks’ Place Memory Care Provide?

Park’s Place provides all the items listed under the average memory care and much, much more.  So what sets us apart?  Using both P-E Fit Model and Transitions Theory, three major ways to assist residents are to improve personal competence, bolster the environment, support transitions, or a combination of all three.  Which is exactly what we do. 

Improve Personal Competence.  As stated earlier in this blog, it is an unrealistic expectation that someone living with dementia will be able to improve his or her personal competence.  If you are searching for a memory care for your loved one, he or she passed the point of being able to adapt their personal competence.  But, our staff is able to bridge the gap so their personal competence meets the environmental press.  For example, we provide assistance for any and all cares from a simple verbal cue to full hands-on assist.  We are able to meet the needs of the resident wherever he or she is in their dementia journey and expand cares as time goes on. 

Additionally, our specialized activity program is designed to be a form of treatment for dementia, not just something for the residents to pass the time.  The activity program helps to orient the residents to the time of day and works within their abilities so that they feel a sense of purpose and productivity.  Because the activity program works within the ability of the residents, it matches their personal competence.  We will also look at activities while discussing transitions. 

Bolster the Environment.  Our home was designed for the person living with dementia.  It is single level with a simple, flowing footprint to allow for residents to safely walk or wander without getting lost.  We are barrier free so residents do not feel a sense of confinement.  Our main area has all the elements of a regular home, including a kitchen, living room, TV room, and a sunroom.  It is designed to make you feel at home and not in an institution.  This helps to reduce the feeling of living in a facility to just moving to a new home, therefore reducing the sense of change for the resident.  Additionally, the overall design and services we provide reduce environmental press for the resident and allows residents to live in fit.

Support Transitions.  As we learned, transitions are not only environmental transitions like moving to a new home, but also cognitive, physical, and emotional.  The environmental transition of moving to a new home will vary from person to person, for some it may be a big change, for others not so much.  Our home is for people of all stages of dementia so they will only need to move once, and experience that transition once, during their dementia journey.  Cognitively, as people transition from one stage to the next, we are able to meet them where they are and adjust the cares, communication, and activities as necessary.  Physically, people with dementia will need more assistance as they progress.  They may go from walking and transferring unassisted to needing a one-person assist, to a two-person assist, to needing a mechanical lift.  Changes in physical ability will also affect other areas such as lifting their arms to wash their body in the shower to lifting eating utensils.  We are able to support our residents during each one of these transitions by increasing the hands-on level of care.  Emotionally, as people age they will begin to lose relationships and friends as the resident is no longer able to recognize friends and family members or those close to them pass away.  Our staff provides emotional support in a variety of ways, by gently reminding residents who their visitors are, providing friendship, and by being a kind, trusted person to provide cares.  We also can design activities or have activities available for residents that are reminiscent or purposeful for them.  These types of activities help to smooth transitions by reducing the perception of a change for the person with dementia.

To learn more about Parks’ Place and how we can support your loved one, call Kaitlin at 612-358-3725 or email her at Kaitlin.kelly@parksplacememorycare.com.

The source used for this blog post can be found here.

Parks’ Place Memory Care is a privately owned assisted living home, specialized and specifically designed for those with Alzheimer’s and other dementias.  Our home is for people of any stage of dementia so they are able to age-in-place in their home.  For tours, general information, or admission inquiry, please contact Kaitlin Kelly at 612-358-3725.

When is it time to intervene?

Early diagnosis of dementia is crucial to preventing a crisis and for planning treatment and care. It is difficult to tell if cognition changes are simply age related changes (normal aging) or dementia (not normal aging).

Therefore, knowing when to seek in-home care or place a loved one in a senior living home is very difficult to judge. This is especially true for individuals without a serious medical condition outside of their cognitive changes.

What is the difference between simple forgetfulness and a serious memory loss?

Here are some warning signs of memory loss that may signal the need for assistance care. They were gathered from a variety of sources:

Does he/she repeat questions more frequently?YesNo
Does he/she exhibit poor grooming and personal hygieneYesNo
Does he/she forget to take medications or take them incorrectly?YesNo
Has there been a change in eating habits or loss of appetite?YesNo
Is outdated food in the refrigerator or little nutritious food?YesNo
 Has driving been impaired? Frequent accidents?YesNo
Is he/she increasingly forgetful?YesNo
 Is he/she moody or depressed?YesNo
Has there been a loss of interest in socializing?YesNo
 Is he/she less interested in former activities?YesNo
 Is he/she unsteady on her feet or does she fall frequently?YesNo
Does he/she have difficulty concentrating?YesNo
Does he/she exhibit poor judgment?YesNo
 Is he/she incontinent?YesNo
Is there trouble handling finances? Are there unpaid bills?YesNo
Does he/she spend long periods of time doing nothing?YesNo
Have others noticed personality changes?YesNo
 Is there unopened mail lying around?YesNo
Is there poor housekeeping or unsafe conditions?YesNo
Does he/she have trouble making decisions?YesNo
 Does he/she get lost?YesNo
 Does he/she have trouble finding the right words?YesNo
Does he/she wear the same clothes over and over again?YesNo

This is also available here has a printable worksheet to fill out and bring to your next appointment with your physician.

See your physician for further evaluation if you have answered “yes” to a majority of these questions. Then call us to learn more about our home and how we can serve your loved one on his or her dementia journey.

Parks’ Place Memory Care is a privately owned assisted living home, specialized and specifically designed for those with Alzheimer’s and other dementias.  Our home is for people of any stage of dementia so they are able to age-in-place in their home.  For tours, general information, or admission inquiry, please contact Kaitlin Kelly at 612-358-3725.

Forgetfulness and Dementia

At times, we all forget details like where we placed our keys or we forget to buy an item on our grocery list. This is normal. Regardless of age, when we are feel stressed or fatigued it is not uncommon to forget details. As a result, many of us develop techniques to aid our memory including checklists, calendars, and “to do lists”.

As people age, the amount of time it takes to learn and retain new information may increase in duration. However, with time and patience normal functioning older adults will be able to retain and recall this new information.

Many older adults are fearful of memory loss. Research shows that there are steps one can take to promote a healthy brain. The Alzheimer’s Association offers the following tips.

Healthy Brain Tips:

Eat healthily: Lean towards foods rich in anti-oxidants and folic acid as well as water and fruit juice. Avoid fatty foods, caffeine, and alcoholic beverages.

  • Stay active: Find activities that exercise your body and your brain.
  • Support system: Maintain a good support system that allows for social interaction.
  • Rest, relax, and sleep: Stress and lack of sleep can have negative effects on your body. Maintain balance within your life.
  • Visit your doctor: Annual physicals allow you to talk with your doctor, ask questions, and monitor your health and medications.

When memory loss becomes more significant

For some, memory loss can be more significant. When memory loss begins to interfere with day-to-day functioning the problem may be a warning sign of something more. For example:

  • Difficulty managing medications
  • Significant weight loss due to missed meals
  • Frequent hospitalizations due to noncompliance with medication regime
  • Inability to organize finances, overdrawn accounts, and vulnerability to scams
  • Disorganized household, decreased cleanliness
  • Failure to meet deadlines at work


Family, friends, and acquaintances should take note when a significant change in skill, routine, or behavior occurs. For example:

  • An accountant who can no longer add 2+2
  • A computer programmer who cannot remember how to turn on the computer


It is important to note that any one of the issues mentioned above alone does not signify memory loss. Instead, it offers a “red flag” which warrants additional attention and investigation.

What to do if memory loss is suspected?

Whenever memory loss is suspected the first step is to see a physician. Your primary physician can refer you to a specialist who can work to identify the cause of the memory loss. Generally, your physician may refer you to a neurologist, internist, and/or a psychiatrist.

Why is a physician visit needed?

Memory loss can have numerous causes. Some medical conditions when left untreated can result in increased confusion and memory loss. As a result, an individual could be diagnosed inaccurately with a form of dementia when, in fact, they may have a medical condition such as a thyroid problem, lack of Vitamin B12, a medication/drug reaction, infection, or depression. A physician will complete a battery of tests to identify any treatable conditions and recommend treatment if appropriate.

If the memory loss and confusion are due to a medical condition, when treated the individual may notice a decrease or elimination of symptoms.

Parks’ Place Memory Care is a privately owned assisted living home, specialized and specifically designed for those with Alzheimer’s and other dementias.  Our home is for people of any stage of dementia so they are able to age-in-place in their home.  For tours, general information, or admission inquiry, please contact Kaitlin Kelly at 612-358-3725.

Mother’s Day at Parks’ Place During a Pandemic

Mother’s Day was a tough but joyful day for our moms and their families.  It was a tough day as we were physically distant from our loved ones, but joyful as we found other ways to connect and show our love.

Feeling Loss

During this time, all of us are feeling loss.  Loss of birthday parties, sporting events, graduations, and loss of spending time with our mothers on Mother’s Day.  Each moment spent together is precious, even more so in memory care as dementia creates an unpredictable future. 

Bitter-sweet, but more sweet than bitter

We knew from the start that this would be a tough day for our residents and their families.  We decided to have a staff member totally dedicated to our moms on Mother’s Day.  Our families were informed that we would be able to facilitate virtual visits, flower and gift delivery, and anything else in-between for their moms on Mother’s Day.  Our virtual visit schedule filled quickly and families informed us of when they would be stopping by with gifts.

On Mother’s Day the virtual visits were bitter-sweet, but more sweet than bitter.  While it was tough for our moms and their families to not be with each other physically, technology like FaceTime and Zoom helped us to feel connected. 

The virtual visits were full of smiles, laughter, and happy tears.  Our staff was brought to tears frequently during the visits at the outpouring of love from the families to their moms.  Many of our mothers showed their loved ones the gift and flower deliveries they received.  But the gifts and flowers were mainly afterthoughts, our moms were really only interested in spending time with their families and seeing their smiling faces.  The time together was truly what brought the most joy to the day.

From Parks’ Place to our moms

Parks’ Place also wanted to show our moms how much we love them so we had a flower delivery for each of them with a card.  We also had a special Mother’s Day treat at lunchtime.  The final thing we did with each of our moms was actually more of a gift to their family.  We made a video of each mother saying what they loved best about being a mom and sent it to their family.  For our mothers whose dementia is a little more advanced we made simpler videos saying thank you for the gifts and cards.  Our families did not know we were making the videos and were so surprised when they received them.

A heartfelt day

Although this was not the Mother’s Day anyone would wish for, it turned out to be a pretty wholesome and heartfelt day.  Our moms were able to spend time with those who call them “mom” and felt their love and support even at a distance.

We are hoping that Mother’s Day 2021 we can welcome all of our families into our home and celebrate with them in-person!

Parks’ Place Memory Care is a privately owned assisted living home, specialized and specifically designed for those with Alzheimer’s and other dementias.  Our home is for people of any stage of dementia so they are able to age-in-place in their home.  For tours, general information, or admission inquiry, please contact Kaitlin Kelly at 612-358-3725.

WCCO-TV Features Parks’ Place Memory Care

Parks’ Place: Memory Care Redefined was featured on WCCO recently, sharing the extraordinary journey of the Parks family, who built Parks’ Place after their husband and father received a diagnosis of Younger-Onset Alzheimer’s. Our care community can accommodate 36 residents and offers a meaningfully planned environment and programming that focuses on abilities rather than disabilities—along with staff members who are passionate about providing highly personalized care to the people they serve. To learn more, contact Kaitlin at kaitlin.kelly@parksplacememorycare.com or call 612-358-3725.